Clinical Use of Cannabinoids for Symptom Control in Multiple Sclerosis

Abstract

The endocannabinoid system was discovered in 1988 but has received little attention for its potential therapeutic possibilities. That has started to change, and since 2000, a significant number of clinical trials of cannabinoids, principally for the control of spasticity in multiple sclerosis, have been undertaken. These studies have been difficult because of the nature of the disease and have involved patients for whom other therapies have failed or proved inadequate. This paper outlines the background to the use of cannabinoids available and discusses the principles of practice associated with their safe use. The focus has been on nabiximols, being the most studied and the only cannabinoid that has been both adequately researched for use in multiple sclerosis and granted a license by the regulators. However, what has emerged is that the effect for many patients can be much wider than just control of spasticity. Within and outside of neurology there seems to be an expanding range of possibilities for the therapeutic use of cannabinoids.

Sex-Dependent Effects of Cannabis and Cannabinoids: A Translational Perspective

“…This is also the case for most laboratory investigations of cannabinoid-induced analgesia in healthy populations (Greenwald and Stitzer, 2000;Naef et al, 2003;Wallace et al, 2007;Kraft et al, 2008;Lee et al, 2013b). Therapeutic effects of cannabis or cannabinoids have also been demonstrated in multiple sclerosis patients (Notcutt, 2015), and cannabinoids may be useful for the treatment of other auto-immune disorders such as rheumatoid arthritis, fibromyalgia, and Crohn's disease (Ware et al, 2010;Katchan et al, 2016;Katz et al, 2016). Although it is difficult to recruit a balanced sample of each sex for human trials of auto-immune disease, one wonders whether the beneficial effects that have been reported thus far are due to the prevalence of women participants in these studies.…”

“…Other potential therapeutic effects for which there are not yet any analyses by sex. While clinical literature suggests that cannabinoids have demonstrated therapeutic effects for the treatment of auto-immune disorders (Ware et al, 2010;Notcutt, 2015;Katchan et al, 2016;Katz et al, 2016), there are no sex difference studies of cannabinoid effects in animal models of auto-immune disease, despite single-sex studies demonstrating promising results (eg, Malfait et al, 2000;Gui et al, 2015;Moreno-Martet et al, 2015). Given that autoimmune disorders are more prevalent in women than men (Klein and Flanagan, 2016), determining whether the greater acute cannabinoid effects observed in female rodents compared to males on some relevant End points (eg, inflammatory pain) extend to models of auto-immune disease is warranted.…”

The Pharmacological Basis of Cannabis Therapy for Epilepsy

“…Cannabinoids are used to treat a variety of nervous system conditions (Wissel et al, 2006;Notcutt, 2015). Many ongoing trials on a diverse range of cannabinoids have shown them to be beneficial for epilepsy (Cunha et al, 1980;Wallace et al, 2001); however, other studies have shown that cannabis can have variable effects on seizures in different species (Meldrum et al, 1974;Martin and Consroe, 1976;Chiu et al, 1979).…”

Cannabinoids/Endocannabinoids As Possible Antineoplastic Therapy In Comparisson To Cancer Pharmacological Treatments Used Today. Narrative Review

“…[31] In multiple studies, the administration of cannabinoids or endocannabinoids reduce tremor. [32] In addition, the control of movement disorders is known because there are high expression of CB1 receptors in areas involved in movement control. [33] At the same places, endocannabinoids can be in great concentration, if necessary.…”